HomeMy WebLinkAboutMortgage_Michel (2)'°n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS o ns ip Year
.; _ --.
� FOR DEDUCTION FROM ASSESSED VALUATION DEC O ZO��
State Form 43709 (R71 / 609)
4' ° PresaibeC bY �P��� of Laal Govemment Flnance
,«. G'J. � ark
�STRUCTIONS:
Fwm
ro 6e filed in person oi by mail with fhe CountyAuditor or Counry Recorder of the counry where the piopeRy is located.
FilirgDates: 1J RealPmperty: Mustfiledunngfheyear/orwhichthedeductionissoughL GIBSON CO NT?.4�UC�Iu� Auditor
2) Mobi7e / Manufactu2d Homes not assessed as Real Property: Must file dunng the tweNe (12J months LJ h'
6efo,e March 31 of each year fhe deducfion is snught ❑ Counry Recorder
See reverse side for additional instruclions and qual�cafions.
Appfi�an�wne�wcarrt.a�fbuyer-see25hic0onsarrevercesitle) n n _ �
Key numDer / legal tlesaiption (/ DO� ,/��' � p
�(a -l„7-D�30(— � o
Mortgage / Contraa'uWebtedness unpaid as of
MarcJi 1, dnrent year
If rw, what is his / her exaU
If name on mcord is d�Rerent Nan Nat of applicant, indicate bebw.
Name of
mortgagee w
Name of assignee w ocher owner or hdder of mor.gage
state.
Atltlress of asvgnee (number antl sneet, dry. sla[e, aiM ZIP code)
Does aPPlinnl own property in anY oUer
munryinlMiana?
❑ Yes
2� � 2�
If yes, whal munq?
2�
spouse.
RecorQ �mber Page numbef
i
unpaid as d Is Me ap�firant the
legal or equitable ovrt
Yes U No
Is Me pmperty in 9���^: �nuallyl�sse55e0
❑ Rea� aroaertv ❑ tvn,ua�y assessea
Mobile Hane (IC 6
'w `ct�''7ry"' S � % l "�/`„ "-'�
:�
m�� QEu3am� ��"
► I- (�5ai
20 � 20
Counry
0
!en requested on Property
Date (manN, daY. Yea�
20
(I/ We certify urWV Ne penalty o�ferjury Nat Ne �6ove and foregoing infortnation is We and cortect arM Na[ ihe applicant is a resident of Indiana aM
owner / mntract buyer of Ne aforemerrtioned pra(�erty on date application is filed.
�Signature (ovmers 7Wl rame) _ Date (nronN, day, yea�
� _ - . , ,,., � n n ,.
Person authorized Dy duty esE
Atltlress of autlionzM person
rmber arM sbee; iily, slate, aM
Power of Attom + or by I 61.1
rer arul sheet, riry, stare, aiM ZII